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EOR Family Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

Peripheral vertigo will present with __________ nystagmus

A

Horizontal

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2
Q

Sudden onset of tinnitus and hearing loss is usually associated with __________ vertigo as compared to central causes

A

Peripheral

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3
Q

Management of nausea/vomiting

A
  1. Antihistamines first line - meclizine, cyclizine, dimenhydrinate, diphenhydramine
  2. Dopamine blockers - metoclopramide, promethazine
  3. Anticholinergics - scopolamine
  4. benzos
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4
Q

S/E of scopolamine

A

Anticholinergic

Dry mouth, blurred vision, urinary retention, constipation

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5
Q

Seizures not provoked by stimuli, occurs without clear cause

A

Epilepsy

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6
Q

Generalized seizure which affects entire cortex. Muscle stiffness followed by muscle jerking. Will often have foaming of the mouth, tongue biting, and/or urination

A

Tonic Clonic Seizure

Grand-mal seizure

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7
Q

Seizure that occurs in one part of the cortex with loss of consciousness

A

Complex partial seizure

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8
Q

Seizure that occurs in one part of the cortex without loss of consciousness

A

Simple partial seizure

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9
Q

Postictal symptoms

A 
Confusion
Amnesia
Headache
Nausea
Difficulty speaking
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10
Q

Paresis that occurs following a seizure that lasts for hours

A

Todd’s Paralysis

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11
Q

Diagnosis for pt with first time seizures

A 
CBC
Electrolytes
Glucose
Calcium, magnesium
Renal function, liver function
Toxicology screen
CT or MRI is also done to r/o masses

If all come back normal, this is termed epilepsy, and EEG is done

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12
Q

Treatment for seizures

A 
First time seizures usually do not require medication
Reasons for therapy to be given:
1. Pt with status epilepticus
2. Prior brain insult
3. EEG with epileptiform abnormalities
4. Brain imaging abnormality
5. Nocturnal seizure
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13
Q

Antiseizure medication with the most evidence for teratogenicity

A

Valproate

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14
Q

Oral contraceptive efficacy may be _______ when started on an epileptic drug, therefore all women of childbearing age should be given _________

A

Reduced

Folic acid

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15
Q

Treatment of choice for absence seizures

A

Ethosuximide

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16
Q

Discontinuation of seizure medication can be attempted after:

A

2 year seizure free period

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17
Q

Seizure that lasts longer than 5 minutes

A

Status epilepticus

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18
Q

Treatment for status epilepticus

A
  1. Benzodiazepine (Midazolam used if no IV access)
  2. After benzo, give fosphenytoin
  3. If seizure persists but stable, phenobarbital
  4. If not stable, intubate and give propofol or midazolam
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19
Q

Episode of neurological deficits caused by focal brain, spinal cord, or retinal ischemia without acute infarction

A

Transient Ischemic Attack

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20
Q

Signs/Symptoms of stroke

A

Abrupt onset of neurological abnormalities
Facial paresis
Arm drift/weakness
Abnormal speech

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21
Q

Signs/Symptoms of hemorrhagic stroke

A

Headache
LOC
N/V

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22
Q

Diagnostic testing of stroke

A
  1. Non-contrast CT to r/o hemorrhage
  2. LP if negative but still suspicious
  3. MRI - localize extent of infarction (after 24 hours)
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23
Q

Other tests for stroke to r/o other dz:

A
  1. Glucose - r/o hypoglycemia
  2. O2 sats
  3. EKG - r/o arrhythmia
  4. CBC
  5. Cardiac enzymes - r/o infarction
  6. PT/PTT
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24
Q

All pts who present within _______ hours of ischemic stroke symptom onset should be offered TPA

A

4.5 hours

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25
Q

All patients who present after 4.5 hour window for ischemic stroke should be given:

A

Aspirin

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26
Q

Patients who have _______________ should not be given TPA

A

Rapidly improving stroke symptoms

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27
Q

In ischemic stroke, blood pressure should be lowered in the case of:

A
  1. Malignant hypertension
  2. Myocardial ischemia
  3. BP > 185/110 and if TPA will be administered
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28
Q

Indications for mechanical thrombectomy in ischemic stroke

A

Occlusion of proximal anterior circulation
No hemorrhage present
Can be done w/n 6 hours

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29
Q

Treatment for hemorrhagic stroke

A

BP therapy - goal is 160/90
Labetalol and nicardipine are first line
If pt on anticoagulants, give reversal agent
Surgical removal or hemorrhage should be done if hemorrhage is > 3 cm in diameter or if patient is deteriorating

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30
Q

Ischemic stroke interventions:

A
  1. ASA within 48 hours
  2. Pneumatic compression stockings or heparin for VTE prophylaxis
  3. Statin therapy
  4. Smoking cessation
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31
Q

Long Term Antiplatelet Therapy after ischemic stroke

A

Aspirin, clopidogrel or aspirin-dipyridamole

if pt was previously on aspirin - switch to clopidogrel or add dipyridamole

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32
Q

After stroke management (diagnostic modalities):

A
  1. Echocardiogram - look for clot
  2. EKG/Holter monitor - r/o AFib/arrhythmia
  3. Carotid duplex US - r/o stenosis
  4. Duplex US, CTA or MRA or head/neck arteries - look for clot
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33
Q

TIAs usually last < ________, but most resolve in ___________

A

24 hours

30-60 minutes

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34
Q

TIAs are most commonly due to:

A

Embolus

or transient hypotension

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35
Q

_____% of patients with TIA will have a CVA within first 24-48 hours afterwards (especially if DM, HTN)

A

50%

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36
Q

Amaurosis Fugax

A

Monocular vision loss - temporary “lamp shade down on one eye”
Seen with internal carotid artery occlusion

37
Q

Symptoms of TIA

A 
Amaurosis Fugax
Contralateral hand weakness
Sudden HA
Speech changes
Confusion
38
Q

Symptoms of TIA

A 
Amaurosis Fugax
Contralateral hand weakness
Sudden HA
Speech changes
Confusion
Gait and proprioception difficulties
Dizziness, vertigo
39
Q

Diagnosis of TIA

A
  1. CT scan of head - r/o hemorrhage
  2. Carotid doppler - carotid endarterectomy recommended if stenosis > 70%
  3. CT angiography, MR angiography
  4. BG to r/o hypoglycemia
  5. Electrolytes
  6. Coag studies
  7. CBC
  8. Echocardiogram
  9. ECG - look for AFib
40
Q

ABCD2 score

A 
Assesses CVA risk
Age
Blood pressure
Clinical features
Duration of symptoms
Diabetes mellitus
41
Q

Management of TIA

A

Aspirin +/- dipyridamole or clopidogrel
Avoid lowering blood pressure (unless > 220/120)
Reduce modifiable risk factors: 1. DM 2. HTN 3. AFib

42
Q

Most common type of dementia

A

Alzheimer Disease

43
Q

Loss of brain cells, amyloid deposition cells (senile plaques) in brain, neurofibrillary tangles (tau protein)

A

Alzheimer Disease

44
Q

Diagnosis of alzheimer disease

A

CT Scan - cerebral cortex atrophy

45
Q

Management of alzheimer disease

A

Ach-esterase inhibitors: Donepezil, Tacrine, Rivastigmine, Galantamine
Does not slow down disease progression
NMDA Antagonist: Memantine

46
Q

Idiopathic dopamine depletion - failure to inhibit acetylcholine in the basal ganglia

A

Parkinson Disease

47
Q

Cytoplasmic inclusions (Lewy bodies), loss of pigment cells seen in the substantia nigra

A

Parkinson Disease

48
Q

Signs/Symptoms of parkinson disease

A
  1. Tremor
  2. Bradykinesia
  3. Rigidity
  4. Facial immobility (fixed facial expressions)
  5. Instability (postural)
49
Q

Parkinson disease tremor

A

Resting tremor most common (pill rolling)
Worse at rest and with emotional stress
Lessened with voluntary activity, intentional movement and sleep
Usually confined to one limb or one side before becoming generalized

50
Q

Often the first symptom of Parkinson’s Disease

A

Resting tremor

51
Q

Slowness of voluntary movement and decreased automatic movements. Ex lack of swinging of the arms while walking and shuffling gait

A

Bradykinesia

Parkinson Disease

52
Q

Increased resistance to passive movement (cogwheel, flexed posture)

A

Rigidity

Parkinson disease

53
Q

Increasing speed while walking

A

Festination

Parkinson disease

54
Q

Tapping of the bridge of nose repetitively causes a sustained blink

A

Myerson’s Sign

Parkinson disease

55
Q

Postural instability in Parkinson Disease

A

Pull test - stand behind patient and pull shoulders

Patient falls or takes steps backwards

56
Q

Dementia is seen in approximately ______% of parkinson disease

A

50%

57
Q

Management of Parkinson Disease

A
  1. Levodopa/Carbidopa (most effective)
  2. Dopamine Agonists: Bromocriptine, Pramipexole, Ropinirole
  3. Anticholinergics: Trihexyphenidyl, Benztropine
  4. Amantadine
  5. MAO-B Inhibitors: Selegiline, Rasagiline
  6. COMT Inhibitors: Entacapone, Tolcapone
58
Q

S/E of Levodopa/Carbidopa (Parkinson treatment)

A

N/V
Hypotension
Somnolence
Dyskinesia

59
Q

S/E of Dopamine Agonists: Bromocriptine, Pramipexole, Ropinirole
(Parkinson treatment)

A 
Orthostatic Hypotension
Nausea
HA
Dizziness
Sleep disturbances
Anorexia
60
Q

S/E of anticholinergics

Parkinson treatment

A

Constipation, dry mouth, blurred vision, tachycardia, urinary retention

61
Q

S/E of COMT inhibitors: entacapone, tolcapone (Parkinson treatment)

A

GI sx

Brown discoloration of urine

62
Q

Postural, bilateral action tremor of the hands, forearms, head, neck or voice. Most common in the upper extremities and head

A

Essential tremor

63
Q

Tremor increases with stress and intentional movement (finger to nose testing) - tremor increases as target is approached

A

Essential tremor

64
Q

Essential tremor is usually shortly relieved with _______ ingestion

A

EtOH

65
Q

Management of essential tremor

A
  1. Treatment not usually needed
  2. Propranolol may help if severe
  3. Primidone if no relief with propranolol
  4. Alprazolam third line
66
Q

Bell Palsy has a strong association with:

A

Herpes Simplex Virus reactivation

67
Q

Risk factors for Bell Palsy

A
  1. DM
  2. Pregnancy
  3. Post URI
  4. Dental nerve block
68
Q

Sudden onset of ipsilateral hyperacusis (ear pain) for 24-48 hours - unilateral facial paralysis

A

Bell Palsy

69
Q

Eye on affected side moves laterally and superiorly when eye closure is attempted

A

Bell phenomenon

70
Q

Differential diagnosis: Bell Palsy vs Stroke

A

If patient is able to wrinkle both sides of forehead, it is NOT bell palsy

71
Q

Management of Bell Palsy

A

No treatment is required - most cases resolve within 1 month

  1. Prednisone
  2. Artificial tears
72
Q

Progressive, chronic intellectual deterioration of selective functions: memory loss and loss of impulse control, motor and cognitive functions. Includes language dysfunction, disorientation, inability to perform complex motor activities and inappropriate social interactions

A

Dementia

73
Q

Risk Factors for dementia

A

Age > 60 y/o

Vascular Disease

74
Q

Signs/Symptoms of cluster headaches

A
  1. Severe unilateral periorbital/temporal pain (sharp, lancinating)
  2. Bouts lasting < 2 hours with spontaneous remission
  3. Bouts occur several times a day over 6-8 weeks
75
Q

Triggers for cluster headaches

A

Worse at night
EtOH
Stress
Ingestion of specific foods

76
Q

Additional symptoms associated with cluster headaches

A

Ipsilateral Horner’s syndrome (ptosis, miosis, anhidrosis), nasal congestion/rhinorrhea, conjunctivitis and lacrimation

77
Q

Management of cluster headaches

A
  1. 100% oxygen first line

2. Meds: sumatriptan or ergotamines

78
Q

Prophylaxis of cluster headaches

A

Verapamil (first line)

Ergotamines, valproic acid, lithium, cyproheptadine

79
Q

Most common cause of morning headache

A

Migraines

80
Q

Risk factors for migraines

A

Family history (80%)

81
Q

Signs/Symptoms for migraines

A

Lateralized, pulsatile/throbbing headache
Associated with N/V
Photophobia/phonophobia

82
Q

Triggers for migraines

A 
Physical activity
Stress
Lack/excessive sleep
EtOH
Foods (red wine, chocolate)
OCPs
Menstruation
83
Q

Auras

A

Seen with migraines (not commonly)

Visual changes most common, aphasia, weakness, numbness

84
Q

Management of migraines

A
  1. Triptans or Ergotamines
  2. Dopamine blockers: metoclopramide, promethazine, prochlorperazine
  3. Mild: NSAIDs/acetaminophen first line
85
Q

S/E of triptans or ergotamines

A

Chest tightness from constriction
N/V
Abdominal cramps

86
Q

Prophylaxis of migraine

A

Anti-HTN meds: BB, CCBs, TCAs

Anticonvulsants; valproate, topiramate, NSAIDs

87
Q

Most common overall type of headache

A

Tension headaches

88
Q

Bilateral, tight, band-like constant daily headache. Worsened with stress, fatigue, noise or glare (not worsened with activity like migraines). Usually not pulsatile

A

Tension headaches

89
Q

Management of tension headaches

A
  1. NSAIDs, aspirin, acetaminophen
  2. Anti-migraine medications
  3. TCAs in severe or recurrent cases
  4. Can use beta blockers, psychotherapy

EOR Family Medicine (14 decks)

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